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Do you remember in medical school when the professor taught us that unless you think of ectopic pregnancy, you couldn't make the diagnosis? The teaching point wasn't specifically for ectopics, but the generalized concept was that we should have a broad differential diagnosis when confronted by a clinical situation in order to maximize our success in making the correct diagnosis.
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The authors reviewed 472 records representing 16 million preventive healthcare visits in women from 50 to 69 years of age in the 2000 National Ambulatory Medical Care Survey. OB/GYN physicians were more likely to follow breast cancer screening guidelines, but, overall, mid-level providers are more likely than medical doctors or osteopaths to adhere to guidelines.
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The increased rate of cesarean section in the United States has been the subject of many editorials over the last 3 years and the very recent spurt in elective cesareans has triggered commentary varying from "this is unconscionable" to "why not?"
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Elnashar and colleagues in Egypt performed a randomized trial assessing the efficacy of adding dexamethasone to clomiphene citrate treatment (up to 150 mg/day). The subjects were 80 women with polycystic ovaries who had demonstrated resistance to clomiphene induction of ovulation and who had normal levels of dehydroepiandrosterone sulfate (DHAS).
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Persistent low levels of serum hCG in the absence of pregnancy or tumor is a perplexing problem that often leads to aggressive interventions including surgery and multi-agent cytotoxic chemotherapy. Given the low prevalence of true disease in these cases, it is not surprising these interventions provide little impact and may, and in fact, prove harmful.
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TNF Blockers: Should You Be Concerned?; FDA Actions
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A 6-year retrospective study shows that 45% of Medicare patients with state-funded drug benefits who initiate a medication for osteoporosis do not continue to take it as prescribed one year later and 52% are no longer compliant 5-years later.
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The FDA has approved a cfc-free levalbuterol aerosol inhaler for the treatment of asthma. Levalbuterol is the active isomer of albuterol and has been available in a nebulized solution for many years. This new formulation is marketed by Sepracor as Xopenex HFA.
